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Background: Acute appendicitis is the most common surgical emergency in children. Differentiation of acute appendicitis from conditions that do not require operative management can be challenging in children. This study aimed to identify the optimum risk prediction model to stratify acute appendicitis risk in children. Methods: We did a rapid review to identify acute appendicitis risk prediction models. A prospective, multicentre cohort study was then done to evaluate performance of these models. Children (aged 5–15 years) presenting with acute right iliac fossa pain in the UK and Ireland were included. For each model, score cutoff thresholds were systematically varied to identify the best achievable specificity while maintaining a failure rate (ie, proportion of patients identified as low risk who had acute appendicitis) less than 5%. The normal appendicectomy rate was the proportion of resected appendixes found to be normal on histopathological examination. Findings: 15 risk prediction models were identified that could be assessed. The cohort study enrolled 1827 children from 139 centres, of whom 630 (34·5%) underwent appendicectomy. The normal appendicectomy rate was 15·9% (100 of 630 patients). The Shera score was the best performing model, with an area under the curve of 0·84 (95% CI 0·82–0·86). Applying score cutoffs of 3 points or lower for children aged 5–10 years and girls aged 11–15 years, and 2 points or lower for boys aged 11–15 years, the failure rate was 3·3% (95% CI 2·0–5·2; 18 of 539 patients), specificity was 44·3% (95% CI 41·4–47·2; 521 of 1176), and positive predictive value was 41·4% (38·5–44·4; 463 of 1118). Positive predictive value for the Shera score with a cutoff of 6 points or lower (72·6%, 67·4–77·4) was similar to that of ultrasound scan (75·0%, 65·3–83·1). Interpretation: The Shera score has the potential to identify a large group of children at low risk of acute appendicitis who could be considered for early discharge. Risk scoring does not identify children who should proceed directly to surgery. Medium-risk and high-risk children should undergo routine preoperative ultrasound imaging by operators trained to assess for acute appendicitis, and MRI or low-dose CT if uncertainty remains. Funding: None.
Appendicitis risk prediction models in children presenting with right iliac fossa pain (RIFT study): a prospective, multicentre validation study
Nepogodiev D.;Wilkin R. J.;Bradshaw C. J.;Skerritt C.;Ball A.;Moni-Nwinia W.;Blanco-Colino R.;Chauhan P.;Drake T. M.;Frasson M.;Gee O.;Glasbey J. C.;Matthews J. H.;Morley G. L.;Naumann D. N.;Pata F.;Soares A. S.;Bhangu A.;Abbas S. H.;Abdelgadir A. M.;Abdelrahman A.;Abdelrahman M.;Abdelwahed A.;Abou El Ella Y.;Abulafi M.;Acharya A.;Adam M. E.;Adams R. E.;Adegbola S. O.;Adimonye A.;Adnan M.;Afshar S.;Ahad A.;Ahel J.;Ahern D. P.;Ahmad Asmadi A.;Ahmed B.;Ahmed G.;Ahmed O. S.;Ahmed S.;Akbari K.;Akinsola O.;Al-Khyatt W.;Al-Sarireh B.;Al-Sheikh M.;Alani M.;Alexander R.;Alhammali T.;Ali M.;Aljorfi A.;Allen M.;Allington J.;Alshafei A.;Amarasinghe R.;Amayo A.;Amin V.;Amuthalingam T.;Anandan L.;Anderson O.;Andreani S. M.;Andrews B.;Ang A.;Aravind B.;Archer J. E.;Aremu M. A.;Arunachalam S.;Aruparayil N.;Ashmore D. L.;Ashour O.;Ashraf N.;Assaf N.;Avalapati H.;Awokoya O. O.;Ayube-Brown J.;Badenoch T.;Bagga R.;Baginski A.;Bailey S.;Bailey S. T. R.;Baird C.;Baker B.;Balai E. J.;Balasubramaniam A.;Bandyopadhyay S. K.;Banks A.;Bansal H.;Barnieh W.;Barrie A.;Barter C. A.;Bastianpillai J.;Beasley W. D.;Bell C. R.;Bell J.;Beral D.;Berry B. J. M.;Bevan K. E.;Bevan V.;Bhanderi S.;Bhargava A.;Bilku D.;Birindelli A.;Blackford O. D.;Blackwell J. E. M.;Blake L.;Blencowe N. S.;Boam T. D.;Boereboom C.;Bogdan M.;Bohra P.;Bolger J. C.;Bolton W.;Bond S.;Borg C. M.;Borghol K.;Boshier P. R.;Bouhadiba N.;Bowen J.;Bowerman H.;Bowman C. R.;Boyd-Carson H.;Bradshaw C. J.;Branagan G.;Brennan P.;Brett M.;Brewer H. K.;Brewer H.;Bronder C.;Brown A.;Brown A. G.;Brown C. E.;Brown M.;Brown R.;Buckley-Jones S.;Budzanowski A.;Bukhari W.;Bull C.;Bullivant J. K.;Burns K. M.;Burnside D.;Busuttil A.;Byrne B. E.;Byrnes C. K.;Caldwell M.;Callan R.;Cameron F. C.;Campbell U.;Campbell U. M.;Campbell W.;Carden C. A.;Carder C. F. W.;Carney K.;Cartwright H.;Cay P.;Chalk A.;Chambers B.;Champsi A.;Chan D.;Chan T. C. W.;Chandler S. B.;Chapman J.;Charalabopoulos A.;Chasty B.;Chatzikonstantinou M.;Cheah W. L.;Chean C. S.;Cheng S.;Cheng S. A.;Cheruvu M.;Chin M. Y.;Chishti I. A.;Choi S.;Chok S. M.;Chong B.;Choong J. H.;Chowdhary M.;Chowdhury F.;Choy C. H.;Christian L.;Christopoulos P.;Chui K.;Cipparrone M.;Clark G. L.;Clarke S. A.;Cleeve S. J.;Clement K. D.;Clements B.;Clements C.;Clements J. D.;Clements J. M.;Clements J. S.;Clements J. A.;Clingan R.;Cloney L.;Clough E. C. S.;Coe P. O.;Collier-Wakefield O.;Colliver D. W.;Colvin D. A.;Connelly T. M.;Connor M. J.;Cook V.;Cooke F.;Cooper F.;Cotton A. E.;Couch D. G.;Cousins L.;Coyle D.;Creasy W.;Cresner R. L.;Crone A.;Cross K.;Crozier J.;Cunha P.;Curtis N. J.;D'Souza N.;Dagash H.;Dalmia S.;Daniels I.;Danquah-Boateng D.;Dar F. A.;Dart K.;Das A.;Daureeawoo R.;Davidson S.;Davidson J. R.;Davies P. L.;Davis S.;Daya Shetty V.;De-Manzoni-Garberini A.;De-Marchi J. A.;Dean E. A.;Dean S.;Delimpalta C.;Denley S.;Dennison G.;Devine A. A.;Dharamavaram S.;Dhari A. A.;Di Franco F.;Di Saverio S.;Dobson C.;Docherty J. A.;Doherty C.;Donaldson G.;Donohoe N. O.;Donohoe O.;Douka E.;Doulias T.;Downey M.;Doyle C.;Drye N.;Du D. T.;Dudek J. G.;Dunning P. G.;Dyal A. R. S.;Eardley N. J.;Earnshaw L.;Easdon S.;Edwards S. E.;Egan R. J.;El-Masry S.;El-Tayar O.;Elbourne C. R.;Elgaddal S.;Elseedawy M.;Elshaer M.;Elsharnoby O. H.;Elzeneini W. M. A.;Emslie K. M.;Engall N. F. T.;Ertansel B.;Esmail H. D.;Ettles C.;Evans J.;Evans J. D.;Everden A.;Fadel M.;Fahmy S. E.;Fairfield C. J.;Fanibi B. F.;Farina V.;Farrell S. M.;Farrow E. Z.;Fasuyi J. A.;Faulkner G.;Fawkner-Corbett D.;Fawzi F.;Fehervari M.;Ferguson N.;Finch J. G.;Finlayson H.;Flack T.;Foers W.;Foley N. M.;Ford K.;Forgie A.;Foster A.;Foster J. D.;Fox A. M. W.;Francis N.;Franklin D.;Froud H.;Fuller H. L.;Gaines E.;Galea J.;Gammeri E.;Garnham J.;Garvin J.;Gates Z.;Gentry R.;Ghaffari I.;Ghatorae S.;Gidwani A. L.;Gilbert T. G.;Gilbert T. 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R.;Irukulla S.;Irwin R.;Islam N.;Ivey P.;Jackson C. R.;Jackson A.;Jah S. M. H.;Jain A.;Jain S.;Jain S.;Jama G. M.;Jamieson N. B.;Janardanan S.;Jasinski B.;Jenner D.;Jerome E.;Johnson B.;Johnstone A.;Jokhan S.;Jones A.;Jones C. E.;Jones C. S.;Jones E.;Jones L.;Kabir U.;Kabwama S.;Kamal M.;Kamande I. W.;Kanakala V.;Kannegieser-Bailey M.;Kaptanis S.;Karim M. J.;Karwal R. S.;Kaur G.;Keegan R.;Kelay A.;Kennedy N. D.;Kent D. A.;Khair A.;Khan K.;Khan S.;Khasria A.;Kho H.;Kilkenny J.;King R.;Kinross J.;Kirkham E. N.;Knight B.;Kochupapy R.;Koh C.;Kouli O.;Krishnamoorthy A.;Krivan S.;Kumar K.;Kumar S.;Kung V. W. S.;Kuo R.;Lafaurie G.;Lai C. W.;Lal N.;Lawday S.;Layman S.;Layton G. R.;Lazzaro A.;Lecky-Thompson L.;Lee K. A.;Lee K. J.;Lee M.;Lee S. L.;Leighton P. A.;Leitch R. P.;Lennox-Warburton H. C.;Leung E. L.;Li C. H.;Lim J. M.;Limb C.;Ljungqvist G.;Lloyd G.;Lodhia S.;Logan P. C.;Long M.;Long P.;Long R. H.;Longshaw A.;Louw C.;Lund J. N.;Ly C.;Lynch Wong M. J.;Ma J. K. 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M.;Mohamed I.;Mohamed T. M.;Mohamed W. O.;Mohd N.;Moore C.;Moradzadeh J.;Morrison T. E. M.;Morrison-Jones V.;Morton D. G.;Mothe B. S.;Motiwala F.;Motter D.;Mowbray N. G.;Mughal Z.;Mulsow J.;Mundkur N.;Muntean A.;Murphy C.;Murphy R.;Murray M. P.;Muzaffar M.;Myatt A.;Nadeem A.;Nagarajan D.;Nagendram S.;Nair A.;Nair M. K.;Nair M. S.;Naismith K. N.;Nambiar K.;Nana G. R.;Nash Z.;Nastro P.;Nazarian S.;Neagle G.;Neale A.;Neary P. M.;Newton R. C.;Ng M.;Ng S.;Niaz O.;Nickson S.;Nicol D.;Nimako E.;Noor Mohamed M. S.;Nyeko-Lacek M.;O'Connor B. R.;O'Neill E.;O'Neill N.;O'Sullivan D.;O'Brien J.;Oakey M.;Obeid N.;Odeh A.;Ogboru S.;Ogbuokiri C.;Okekunle B.;Okorocha E.;Olagbaiye O.;Olivier J. B.;Ooi R.;Orawiec P.;Orizu M.;Orme N.;Ormiston R.;Paget C.;Pal A.;Palani-Velu L. K.;Pan Y.;Panda N.;Pandey V.;Pandya R.;Pandya D.;Paramasevon K. R.;Pardy C.;Parkola M. J.;Pasquali S.;Patel A. S.;Patel B. Y.;Patel C.;Patel H.;Patel N.;Patel R. T.;Patel S.;Patel Y.;Patel M. M.;Patil S. D.;Payne C. J.;Payne R. 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F.;Savill A.;Savioli F.;Schuster Bruce J. R.;Sebastian J. F.;Seddon T. C.;Seneviratne N.;Seth M.;Setshwaelo T.;Sezen E.;Sgardelis P.;Sgro A.;Shah C.;Shah J.;Shah K.;Shah S. M.;Shakoor Z.;Shalaby M. S.;Shanmuganathan V.;Shanmugarajah K.;Sharma A.;Sharma P.;Sharp O. L.;Shepherd J. A.;Sherif M. A.;Shet S.;Shingler G.;Shiwani M. H.;Shreshta D.;Sian T.;Siddiqui M. N.;Siddiqui Z. A.;Siggens K. L.;Sihra N.;Silva I.;Simioni A.;Simmonds L. F. C.;Simpson D. J.;Singh A.;Singh S.;Singhal T.;Sivaloganathan P.;Sloan K.;Smallcombe N.;Smart C. J.;Smart N. J.;Smith R.;Smoker H.;Solinas L.;Souter J. E. H.;Springate E. L.;Stephens G. F.;Stevenson R.;Stewart D. J.;Stoica I.;Strachan E.;Stubbs B. M.;Stupalkowska W.;Suliman A.;Sultana A.;Sunter H.;Suriyakumar S.;Symons N. R. A.;Szentpali K.;Szucs A.;Tabain V.;Tague L. E.;Tailor K.;Tan C. Y.;Tan S.;Tang A. M.;Tarazi M.;Tay Y. H.;Tayeh S.;Taylor M.;Taylor N. S.;Taze D.;Teasdale E.;Thakral N.;Thava B.;Thavanesan N.;Thaventhiran A. J.;Theodoropoulou K.;Thomas A. T.;Thomas L.;Thompson D. B.;Thompson R.;Thoukididou S. N.;Tiboni S. G.;Tiedt L. A.;Ting N.;Tinsley B. J.;Tognarelli J. M.;Torkington J.;Torrance A.;Townsend D. C.;Tozer P. J.;Trail M.;Trew F.;Tudyka V.;Tullie L.;Turnbull A.;Turner E. J.;Twum-Barima C. S.;Tyler R.;Vakis S.;Valle A. L.;Van Boxel G. I.;Vance-Daniel J.;Varcada M.;Varma N.;Vaughan E. M.;Velchuru V. R.;Velho R.;Venkatasubramaniam A. K.;Venn M. L.;Vijay V.;Vinnicombe Z.;Vitish-Sharma P.;Wagener S.;Waite K.;Walters K. J.;Walters U.;Wardle B. G.;Wardle S. D.;Warusavitarne J.;Watfah J.;Watson N.;Wauchope J.;Weatherburn L. W.;Weegenaar C. R.;Welsh S.;Wheatstone S.;Whewell H. E.;Whitehouse P.;Whiteman E.;Whittaker L.;Wijesundera K.;Wilkinson D.;Williams G. L.;Williams M.;Williams R.;Williams S.;Wilson E. J.;Wilson M. S. J.;Winter D. C.;Winter G.;Wolff J.;Wong A.;Wong C. L. L.;Wong S. Y.;Wood C. S.;Woodrow C.;Woodward A.;Woodward B.;Wright E.;Wright H. L.;Wu F.;Yalamarthi S.;Yang P.;Yardimci E.;Yasin T.;Yen S. K.;Yoganathan S.;Yoong S.;Youssef H.;Yow L. P. S.;Zaborowski A.;Zadi A. Z.;Zarka Z. A.;Zarog M. A.;Zhang A. Y.
2020-01-01
Abstract
Background: Acute appendicitis is the most common surgical emergency in children. Differentiation of acute appendicitis from conditions that do not require operative management can be challenging in children. This study aimed to identify the optimum risk prediction model to stratify acute appendicitis risk in children. Methods: We did a rapid review to identify acute appendicitis risk prediction models. A prospective, multicentre cohort study was then done to evaluate performance of these models. Children (aged 5–15 years) presenting with acute right iliac fossa pain in the UK and Ireland were included. For each model, score cutoff thresholds were systematically varied to identify the best achievable specificity while maintaining a failure rate (ie, proportion of patients identified as low risk who had acute appendicitis) less than 5%. The normal appendicectomy rate was the proportion of resected appendixes found to be normal on histopathological examination. Findings: 15 risk prediction models were identified that could be assessed. The cohort study enrolled 1827 children from 139 centres, of whom 630 (34·5%) underwent appendicectomy. The normal appendicectomy rate was 15·9% (100 of 630 patients). The Shera score was the best performing model, with an area under the curve of 0·84 (95% CI 0·82–0·86). Applying score cutoffs of 3 points or lower for children aged 5–10 years and girls aged 11–15 years, and 2 points or lower for boys aged 11–15 years, the failure rate was 3·3% (95% CI 2·0–5·2; 18 of 539 patients), specificity was 44·3% (95% CI 41·4–47·2; 521 of 1176), and positive predictive value was 41·4% (38·5–44·4; 463 of 1118). Positive predictive value for the Shera score with a cutoff of 6 points or lower (72·6%, 67·4–77·4) was similar to that of ultrasound scan (75·0%, 65·3–83·1). Interpretation: The Shera score has the potential to identify a large group of children at low risk of acute appendicitis who could be considered for early discharge. Risk scoring does not identify children who should proceed directly to surgery. Medium-risk and high-risk children should undergo routine preoperative ultrasound imaging by operators trained to assess for acute appendicitis, and MRI or low-dose CT if uncertainty remains. Funding: None.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11584/324222
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
